Recovery through connection

Abstract

Interpersonal violence is a critical public health concern that affects individuals across the lifespan. As social beings, social connection can serve to aid in healing from violent experiences and has both direct and indirect effects on physical and mental health. In the general U.S. population, gender differences in social support and victimization experiences have emerged. In U.S. military veterans, little is known about gender differences because few studies include enough women to draw conclusions, and men veterans underreport victimization experiences. With survivors of sexual violence, evidence suggests that disclosure response is linked to short-term health outcomes, but few have explored the perceived long-term impacts of disclosure responses on survivors. Important gaps remain in our understanding of critical periods for intervention with victimized populations and the trajectories of healing for at risk populations (e.g. military veterans). To address these gaps, my dissertation seeks to understand relationships among social connectedness and recovery from interpersonal violence. To achieve this goal, I use multiple methodologies across three studies. My first two studies utilize a longitudinal dataset of U.S. military veterans for quantitative investigation of causal relationships between victimization experiences, potential moderating factors such as social support, and long-term health outcomes. My third study employs qualitative methods with data from 45 sexual violence survivors to delve into meaning made from the social experience of disclosure of their traumatic experiences. Bronfenbrenner's theory of human bioecological development and Harvey's ecological model of trauma both guide my dissertation in conceptualization of the traumatic impacts of violence in the context of personal, environmental, and social factors over time. The first two dissertation studies involve a sample of 673 post-9/11 U.S. military combat veterans and examine two distinct research questions. In Study 1, I examine revictimization, here defined as sexual or physical assault in adulthood following childhood maltreatment, and factors associated with victimization over time to better understand how to prevent revictimization and poor health outcomes in our veterans. Using multilevel logistic models, I found that women, Navy veterans, and those with posttraumatic stress symptoms were at significantly higher risk of revictimization across time, compared to counterparts. Social support while in the military was protective against revictimization. My work can inform intervention and prevention efforts with veterans by identifying risk and protective factors that may intercede between childhood abuse and adult revictimization experiences during military service and associated negative health outcomes after discharge, which include a high risk of suicide. For Study 2, I examine social support over time for the same group of veterans. My findings suggest that there are no gender differences in social support, but that veterans with complex trauma histories are at risk for lower social support over time. In addition, veterans who started with high social support maintained this level of support over time, while veterans who started at a social deficit were not able to increase their social support over the study period. I also found that African American, Latinx, and veterans with lower annual income reported lower social support across time. This suggests that the social position of these groups may present barriers to social resources. Low social support was also related to severe posttraumatic stress and active suicidal ideation in my sample. This work can identify critical periods to intervene to support veterans who are reintegrating into our communities and illuminate risk factors to screen for in clinical practice. In Study 3, I listened to the perspectives of survivors of sexual violence, which are often neglected, to gain a deeper understanding of their disclosure experiences and how they believe it impacted their lives. I used constant comparative analysis to identify several themes, including subtypes of positive and negative responses to disclosure and long-term impacts on healing and relationships. My findings suggest disclosures are a critical point for potential intervention after sexual violence. It is through the disclosure process that survivors can be supported and empowered to connect with others and move further along in their journey towards healing and recovery. Public awareness and promotion of aspects of positive responses could be targeted at children and youth, so that the next generation is equipped with the tools to support each other in difficult times, particularly in the aftermath of sexual violence. Together, my three studies provide a key thread of new knowledge about the experiences and trajectories of survivors of interpersonal violence over time, and how the support of others may contribute to recovery and favorable mental health outcomes. --Author's abstract